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5.1. SR 10-04-2004
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5.1. SR 10-04-2004
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1/21/2008 8:33:56 AM
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10/4/2004
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<br />CIVIC AND COMMUNITY ACTIVITIES: <br /> <br />Describe past or present civic and/or community activities that may be relevant in qualifying you to <br />serve on this board or commission. <br /> <br />I S"""-ve..6 OIA.. +\-\e... COIMf''<""el.AeM':>tve. ?\c.."'- Tc...~~ \=o.'C.e.. <br /> <br />ATIENDANCE: <br /> <br />Are you aware of the importance of regular meeting attendance including the time commitment <br />involved in pr<;paring for meetings, and do you feel you have the time available to be an active <br />participant L Yes _ No <br /> <br />Comments: <br /> <br />CONFLICT OF IN1EREST: <br /> <br />I wish to disclose the following potential conflicts of interest that mayor will arise if I become a <br />member of this board or commission. (See attached "Conflict of Interest" Ordinance) <br /> <br />10oll\e....-. <br /> <br />I)~ Ct ..h~ <br /> <br />Signature <br /> <br />g - d. 3 - d-OO 4- <br />Date <br /> <br />------------------------------------------------------------------------------------------ <br /> <br />The selection process will vary according to the number of applicants and vacancies, and may not <br />include interviews with all candidates. <br /> <br />THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR COMMISSION. <br /> <br />Return Application To: <br /> <br />City of Elk River <br />City Clerk's Office <br />13065 Orono Parkway <br />Elk River, MN 55330 <br /> <br />OFFICE USE <br /> <br />Appointed To: <br /> <br />Date Appointed: <br /> <br />T em1 Length: <br /> <br />Phone: 763.635-1000 <br />Fax: 763.635-1090 <br />www.ci.dk-nver.mn.us <br /> <br />S:clerk/banL:omjapplication/application <br />
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